Saturday, September 08, 2012

Transgenerational transmission of trauma and resilience


This article recently appeared in BMC Psychiatry, then was shared via Creative Commons License on BioMed Central. Transgenerational trauma (the term most often used in Holocaust survivor studies) and intergenerational trauma (the term most often used in Native American research) are finally becoming more accepted in the social sciences. Therapists often see this is sexual trauma, neglect or abuse, mental illness, and addictions being passed either directly or indirectly from one generation to the next.

This paper looks specifically at Brazillian survivors and their families - and while the authors caution that the results cannot be generalized, they confirm previous studies as well as making a solid case for intergenerational resilience.

Transgenerational transmission of trauma and resilience: a qualitative study with Brazilian offspring of Holocaust survivors

Luciana Lorens Braga, Marcelo Feijó Mello, José Paulo Fiks


Abstract


Background
Over the past five decades, clinicians and researchers have debated the impact of the Holocaust on the children of its survivors. The transgenerational transmission of trauma has been explored in more than 500 articles, which have failed to reach reliable conclusions that could be generalized. The psychiatric literature shows mixed findings regarding this subject: many clinical studies reported psychopathological findings related to transgenerational transmission of trauma and some empirical research has found no evidence of this phenomenon in offspring of Holocaust survivors.
 

Method
This qualitative study aims to detect how the second generation perceives transgenerational transmission of their parents' experiences in the Holocaust. In-depth individual interviews were conducted with fifteen offspring of Holocaust survivors and sought to analyze experiences, meanings and subjective processes of the participants. A Grounded Theory approach was employed, and constant comparative method was used for analysis of textual data.
 

Results
The development of conceptual categories led to the emergence of distinct patterns of communication from parents to their descendants. The qualitative methodology also allowed systematization of the different ways in which offspring can deal with parental trauma, which determine the development of specific mechanisms of traumatic experience or resilience in the second generation.


Conclusions
The conceptual categories constructed by the Grounded Theory approach were used to present a possible model of the transgenerational transmission of trauma, showing that not only traumatic experiences, but also resilience patterns can be transmitted to and developed by the second generation. As in all qualitative studies, these conclusions cannot be generalized, but the findings can be tested in other contexts.

Full Citation:
Braga, LL, Mello, MF,  Fiks, JP. (2012, Sep 3). Transgenerational transmission of trauma and resilience: a qualitative study with Brazilian offspring of Holocaust survivors. BMC Psychiatry; 12:134. doi:10.1186/1471-244X-12-134

Here is the background section of the paper, which offers some useful information on this topic. Follow the link at the top to read the whole article.

Background

More than 50 years after the liberation of Nazi concentration camps, researchers and clinicians are still devoted to studying the long-lasting consequences of the traumatic experiences endured by Holocaust survivors and their descendants. This is probably the most comprehensively researched case of transgenerational transmission of trauma [1]. Despite this, there are no published studies conducted with Brazilian offspring of Holocaust Survivors (OHS).

This phenomenon has importance beyond the study of OHS. Many studies suggest that genocides in Rwanda, Nigeria, Cambodia, Armenia, and former Yugoslavia brought about distinct psychopathological symptoms in offspring of survivors [2]. Depression, posttraumatic stress disorder (PTSD), attention deficits, and behavior disorders were more pronounced in children of tortured parents, as compared to controls [3].


In the medical literature, the first study concerning the transgenerational effects of trauma in OHS was published in 1966. The author, Dr. Vivian Rakoff, was researcher at the Jewish General Hospital in Montreal, a city where thousands of Holocaust survivors had settled [4]. Then, other psychiatrists and psychologists who were also treating OHS published case reports of their own [5-7], proposing that the psychiatric disorders of these patients were the result of a “survivor syndrome” [8] perpetuated from one generation to the next [9].


The idea that a parental traumatic experience could reach the second generation soon gained consistency. Clinical studies [10-13] reported a wide range of affective and emotional symptoms transmitted over generations: distrust of the world, impaired parental function, chronic sorrow, inability to communicate feelings, an ever-present fear of danger, pressure for educational achievement, separation anxiety, lack of entitlement, unclear boundaries, and over-protectiveness within a narcissist family system.
 

Although clinical data provided evidence of psychopathologic effects on OHS, some methodological limitations were apparent: predominance of case reports, unclear definitions of psychopathology, small sample sizes, sampling biases, absence of control groups, and lack of standardized instruments [14].

The literature on the “Second Generation” has grown quickly and profusely since the mid-1980s. Controlled studies have confirmed that Holocaust trauma has psychological impacts on the children of survivors [15], such as higher levels of childhood trauma, increased vulnerability to PTSD and other psychiatric disorders [16,17].

Conversely, other studies have pointed out that OHS were in no way affected in terms of personal adjustment [18-20] and that differences between OHS and control groups could suggest a specific character organization rather than psychopathology [21,22]. Specific types of interpersonal relations were found in OHS, and were related to the pattern of parental communication regarding the Holocaust [23,24]. No evidence of personality disturbances was showed in methodologically sophisticated studies conducted with nonclinical samples of OHS [25,26].


A series of meta-analytical studies conducted with second generation [27] and third generation [28] offspring found no evidence of transgenerational transmission of trauma, except in studies conducted with “selected” samples. These resilient patterns were widely described in literature and, for the purpose of this study, we adopted the definition of resilience provided by the American Psychological Association: “the process of adapting well in the face of adversity, trauma, tragedy, threats, or even significant sources of stress – such as family and relationship problems, serious health problems, or workplace and financial stressors. It means 'bouncing back' from difficult experience” [29].


There are three critical conditions in almost all definitions of resilience: “(i) growing up in distressing life conditions and demanding societal conditions that are considered significant threats or severe adversities, (ii) the availability of protective factors, including internal assets and external resources that may be associated with counteracting the effects of risk factors, and (iii) the achievement of positive adaptation despite experiences of significant adversity” [30].


The review of the literature suggests that current studies on transgenerational transmission of trauma to OHS are not conclusive. There is no consensus between the clinical observations and empiric research on the existence of long-term psychological effects on Holocaust survivors and their offspring [31,32]. Whereas case reports are indicative of transgenerational transmission of trauma [33], systematic studies have found no psychopathologic manifestations in the children of Holocaust survivors, except when they were exposed to lifethreatening situations [34,35].


The objective of qualitative studies [36-38] is to explore conceptual aspects [39] and understand different meanings and nuances of these apparent contradictions between clinical research and controlled methodologies. The present study aims to detect how Brazilian OHS perceive transgenerational transmission of their parents‟ experiences in the Holocaust. We should point out that studying specifically this sample is an important data, in as much as the vast majority of the specific literature is based on American, European or Israelite population. The immigration of the first generation to Brazil and the Brazilian culture itself could play a diverse role in the experience of being offspring of Holocaust survivors.

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